Test and Treat to End HIV in 40 Years

posted: 22/02/2010

A global public health strategy for testing and treating everyone with HIV is now being considered.
Health officials are considering a radical shift in the strategy against HIV that would see everyone tested for the virus and people with HIV then put on a lifetime course of drugs. The strategy, which would involve testing most of the world's population for HIV, aims to reduce the transmission so much that HIV would die out completely over the next 40 years.
 

Brian Williams, professor of epidemiology at the South African Centre for Epidemiological Modelling and Analysis in Stellenbosch, said that HIV transmission could be stopped within five years with the use of antiretroviral drugs (ARVs). "The epidemic of HIV is really one of the worst plagues of human history," Williams told the American Association for the Advancement of Science meeting in San Diego. "I hope we can get to the starting line in one to two years and get complete coverage of patients in five years. Maybe that's being optimistic, but we're facing Armageddon."
 

Two years of trials now
Major trials of this universal test and treat strategy are planned in Africa and the USA and will affect whether this becomes part of global public health policy in the next two years.
More than 30 million people are infected with HIV globally and two million die of the disease each year. But across the globe only 12% of those living with HIV get the treatment they need. The disease is overwhelmingly prevalent in sub-Saharan Africa, which accounts for a quarter of all HIV cases globally. Half of these are in South Africa.
 

Broadly the epidemic calculations are that a person with HIV may pass on HIV to between five to 10 others in their time with HIV. Treating people within a year of becoming infected can reduce transmission tenfold, enough to cause the HIV epidemic to die out.
 

Trials plans
In the trials, people will be offered HIV tests once a year, either as routine when they visit their GP, or through mobile clinics in more remote regions. Those testing positive will be put on a lifetime course of ARVs.
"Over the past 25 years we have saved the lives of probably two to three million people using antiretroviral drugs, but almost nothing we have done has had any impact on transmission of the disease," Williams said. "We have stopped people dying but we haven't stopped the epidemic."
If patients take ARVs when they should, the amount of virus in their bodies should fall so low that it becomes undetectable, and they are then extremely unlikely to pass the virus on.

Five years to see the results but worth the price
"The question is, can we use these drugs not only to keep people alive, but also to stop transmission and I believe that we can. We could effectively stop transmission of HIV in five years." Scientists estimate that the cost of implementing the strategy in South Africa alone will be $3bn-$4bn a year. The world currently spends $30bn (£19.4bn) a year on HIV research and treatment, a figure that some experts believe will double over the next decade.
 

Sub-Saharan Africa has seen a dramatic rise in cases of tuberculosis among HIV patients, who are also susceptible to other infections because their immune systems are weakened.
"If you factor in all of the costs, in my opinion, doing this would be cost saving from day one, because the cost of the drugs would be more than balanced by the cost of treating people for all of these other diseases and then letting them die," Williams said. "We're killing probably half a million young adults every year in the prime of their life just at the point where they should be contributing to society and the cost of that to society is enormous," he added. "The only thing that's more expensive than doing this is not doing this."
 

HIV patients in southern Africa are more likely to take ARVs when they should than people living in developed countries, according to health officials. The finding gives doctors hope that the blanket administering of drugs might suppress the virus enough that it dies out naturally.

George House Trust comment 

This assumes a great deal. We are still a long way from providing treatment to all the millions of people in sub-Saharan Africa who need it. This strategy would require us to deliver HIV treatment for vastly more people, reliably, day after day, for decades.

The computer prediction of the epidemic will be correct as long as every African does get tested for HIV every year, everyone who tests positive then starts taking antiretrovirals immediately and 98 out of 100 do not miss a dose. How would people in the UK respond if outsiders decided all adults in the UK must have a HIV test every year?

We know gay men in rich countries use condoms far less now than before effective treatment became available in the mid 1990s, but somehow it's assumed heterosexuals in Africa won't also use condoms less.  

Source

 

Help Haiti Earthquake HIV Healthcare

posted: 20/01/2010

Organisations providing HIV treatment and care in Haiti need urgent donations to support their earthquake relief efforts. They already have a lot of experience providing health care in Haiti, and need to do far more because of the extensive damage caused by last week’s devastating earthquake.

HIV worst in Caribbean

Haiti has by far the worst HIV epidemic in the entire Caribbean region.

Partners in Health  has worked in Haiti for nearly 20 years, and has over 100 doctors, 600 nurses and 4000 employees in Haiti working from 10 Partners in Health hospitals providing relief services to those affected by last week’s earthquake. They urgently need donations and medical volunteers; visit StandwithHaiti for further information.

Partners in Health developed a pioneering HIV treatment programme in Haiti, which demonstrated that it was possible to deliver antiretroviral treatment successfully in one of the world’s poorest countries.

MSF  has been operating in Haiti for 19 years and has great experience in HIV and TB care. Now it focusing on running its three hospitals with operating theatres in Port au Prince to perform urgent, lifesaving surgery. Find out how to donate here.

HIV clinic director was meeting Prime Minister when earthquake struck

Weill Cornell Medical College is collecting donations for GHESKIO, which provides HIV and TB care in Port au Prince. Staff at GHESKIO describe how they are trying to continue providing care to thousands of patients with HIV and TB here, while dealing with earthquake damage and casualties. Their Port au Prince HIV clinic is shown above - the picture was taken before the earthquake - the clinic is badly damaged but still standing. The director Dr Jean Pape says - 'I was at a meeting with the Prime Minister, The Minister of Health, the Director General, the Directors of WHO and UNAIDS, USAID staff, others when it all started. We were all able to get out before the room collapsed.' Help the clinic here 

Film-maker and journalist Anne-Christine d’Adesky, who has reported extensively on the global epidemic and has family connections to Haiti, is blogging daily on the situation in Haiti and is providing a comprehensive overview of responses here.

Family Health International, which has worked extensively in Haiti, is also seeking donations for relief efforts.
 

In the USA Aid for AIDS International is collecting unused medicines from people in the USA for shipping to Haiti.
 

source

UN to Uganda - Scrap Anti-Gay Laws

posted: 18/01/2010

The UN's top human rights official has called on Uganda to drop its proposed anti-homosexuality law that would impose the death penalty on gay and lesbian people with HIV, among others. Navi Pillay, the UN's high commissioner for human rights, joined a growing chorus condemning the bill as discriminatory and called for homosexuality to be decriminalised in the country.
 

"The bill proposes draconian punishments for people alleged to be lesbian, gay, bisexual or transgendered – namely life imprisonment, or in some cases, the death penalty," she said. "To criminalise people on the basis of colour or gender is now unthinkable in most countries. The same should apply to an individual's sexual orientation."
 

Bill fails human rights standards
Pillay called on the Ugandan ¬government to put the draft bill on hold because it breaches international human rights standards. ¬Pillay said Uganda had a generally "good track record" of co-operating with human rights mechanisms but the bill "threatens to seriously damage the country's reputation in the international arena".
The UN said Uganda's parliament may discuss the bill as early as this week. It has provoked criticism from western governments and gay rights groups and protests in London, New York and Washington.
 

President worries about threat to international aid

President Museveni has recently begun distancing himself from the bill. In his first public comments on the issue, he told a meeting of his ruling party that their handling of the bill "must take into account our foreign policy interests".
He said: "When I was at the Commonwealth conference, what was [the Canadian prime minister, Stephen Harper] talking about? The gays. UK prime minister Gordon Brown ... what was he talking about? The gays."
Nsaba Buturo, the ethics and integrity minister, has said a revised law would now probably limit the maximum penalty for gay people with HIV to life in prison rather than execution.
 

Existing anti-gay law has 14 year jail penalty
Homosexual acts are already punishable by up to 14 years in jail in Uganda. The private member's bill, tabled last year, would raise that penalty to life in prison. And it proposes the death penalty for a new offence of "aggravated homosexuality" – defined as when one of the participants is a minor, or HIV-positive, or a "serial offender".
 

Sneaks and harassers charter
It could also lead to a prison sentence of up to three years for anyone failing to report within 24 hours the identities of any lesbian, gay, bisexual or transgendered person.
A local independent newspaper, the Daily Monitor, quoted parliament's speaker as saying the legislative body would debate the bill despite President Museveni's call for more talks. Edward Ssekandi said: "There is no way we can be intimidated by remarks from the president to stop this bill."
 

Source
 

USA HIV Travel Ban Goes

posted: 13/01/2010

On 4 January the USA travel ban on people living with HIV was finally ended. Notoriously the Dutchman Hans Paul Verhoff was refused entry into the U.S. in 1989 to speak at a HIV conference in San Francisco. Many people then boycotted the 6th International Conference on AIDS in San Francisco in 1990.

What began first as an administrative ban then became law in 1987 (through action by the homophobic republican Senator Jesse Helms) and this was reinforced in 1993.
 

The travel ban prevented visits to the USA by people with HIV apart from in exceptional circumstances. Officially people with HIV had to apply for a special permission. It was a difficult and slow process and many were refused. The stigmatising nature of the ban was reinforced because your passport was marked in a way which showed you have HIV.

The ban was widely ignored, but often people with HIV were detected by US immigration staff and then refused entry and deported. Others took risks with their health by interrupting their HIV treatment to enter without HIV being discovered.

Washington 2012 International AIDS Conference confirmed

Now the ban has been lifted the International AIDS Society has confirmed that the 2012 International AIDS Conference will be held in Washington DC. 3 in 100 living in the US capital have HIV, well above the threshold for a severe, generalised epidemic, which is 1%.

UK passport holders with HIV who wish to visit the US can now complete the green 'visa waiver' form that allows routine entry to the USA.

South Korea relaxes rules
The South Korean government has also announced that entry restrictions on people who don’t need a visa to enter were lifted from January 1st.

International HIV travel summary
A list of countries and their entry policies for people with HIV can be in NamLife here.

HIV Drugs Patent Pool

posted: 18/12/2009

An international agreement to pool drug patents for HIV treatments has just been launched, putting even more pressure on drug companies to give up their monopoly rights to HIV drugs. The idea is to make low cost treatment far more widely available in poorer countries.
 

Unitaid, an international drug purchasing facility, voted for the pool in Geneva this week. It was welcomed by campaigners and the British government, which has strongly backed the idea.
 

Campaigners say millions of lives could be saved by drug companies giving up their patent rights to allow anti-HIV drugs to be produced cheaply by generic manufacturers. It would also allow different companies' drugs to be combined in simple-to-take multi-drug combination pills for people in the developing world.
 

The rich multi-national patent-holding drug companies would get a royalty in exchange while keeping their exclusive 20-year patent rights in wealthy countries.
 

'Victory' for developing world
"The Unitaid decision is a huge victory for those in need of HIV treatment around the world," Diarmaid McDonald, the co-ordinator of the umbrella group Stop Aids, said. "It will help to break down the patent barriers which stop people getting the drugs they need to stay alive. Unitaid and the UK government should be commended for their leadership on this." McDonald said the focus "now shifts to the big drug companies", adding: "It will test the sincerity of their rhetoric on helping the most vulnerable in our world."
 

People Campaigning

A grass roots campaign is asking people to email the ten leading drug multi-nationals with HIV patents to ask them to take the patent pool plunge.

Drug companies divided
"Companies like Gilead and Merck showed real leadership within the industry by speaking positively of the patent pool – they must now go beyond words and contribute their patents to the pool. The pressure will be on others within the industry to follow or to explain why they are willing to turn their backs on an initiative with such huge potential to save lives."
 

A small number of companies have so far shown a willingness to discuss flexibility over their patents, but the British firm GlaxoSmithKline (GSK) – a leading manufacturer of HIV drugs – is not interested.
Andrew Witty, GSK’s chief executive, said this summer that he had reservations and believed the company's price cuts and other initiatives would produce better results.
 

GSK under more pressure
McDonald said there had been meetings with GSK, but stressed that the company was a long way from committing to any involvement. "They have come up with lengthy questions and hesitations and concerns about the patent pool and have been less than co-operative in how they have engaged with the Unitaid task force," he added. "The pressure is going to increase on GSK to justify their rationale for walking away from an initiative which could save millions of lives."

Treatment at the crossroads
The international development minister, Mike Foster, applauded the board's decision. "The international community is at a crossroads in meeting the demand for HIV treatment," he said. "Last year, 2.7 million people were newly infected with HIV and 2 million people died from Aids – the need to make effective HIV medicines affordable for developing countries has never been greater. The Unitaid patent pool could be a key means of addressing the treatment crisis."
 

The UK is a founder member of Unitaid, along with Chile, Brazil, Norway and France. Much of its funding comes from a tax on airlines.
 

Michelle Childs, the policy director at Médecins Sans Frontières, the volunteer doctors organisation that pioneered the use of HIV drugs in the developing world, said the pool would be judged by its outcome. "We've been encouraged by the positive responses from a number of companies to our campaign in support of the pool," she said.
 

"Now that the pool has been given a green light, patent holders need to move from expressions of general support to firm and formal license commitments. We urge them to do so. This needs to happen fast as the clock is ticking for millions of patients."
 

Source

Unitaid report